Provider Demographics
NPI:1942630082
Name:SMYTH COUNTY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:SMYTH COUNTY COMMUNITY HOSPITAL
Other - Org Name:MSMG FP GLDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:EICHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-431-1017
Mailing Address - Street 1:636 S MONTE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GLADE SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:24340-2712
Mailing Address - Country:US
Mailing Address - Phone:276-429-5163
Mailing Address - Fax:276-429-5515
Practice Address - Street 1:636 S MONTE VISTA DR
Practice Address - Street 2:
Practice Address - City:GLADE SPRING
Practice Address - State:VA
Practice Address - Zip Code:24340-2712
Practice Address - Country:US
Practice Address - Phone:276-429-5163
Practice Address - Fax:276-429-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073519377Medicaid
VADV0636OtherRAILROAD MEDICARE
VADH1427OtherRAILROAD MEDICARE
VA1073519377Medicaid
VAD244Medicare PIN